Compassion fatigue: The cost of caring


Jayne Ellis of EF Training talks about how to support staff suffering from compassion fatigue.


  • The pandemic has caused a lot of suffering and heartache for those working in education, and schools are realising that investing in the emotional health and wellbeing of their staff is essential.
  • Compassion fatigue is when staff suffer from remarkably similar symptoms to those they are caring for, even though the trauma is not happening directly to them.
  • Compassion fatigue has four phases: anxiety, irritability, withdrawal and robot.
  • Once staff know how to strengthen and maintain their emotional resilience through training, they are able to use the tools they have been taught and sickness rates go down.

If I asked you to list some of the most dangerous jobs, I’m guessing you would name the armed forces, astronauts or deep-sea fishing and yes, these all come with considerable physical risk. But what about working in education? Would you consider this ‘dangerous’?

People begin work in education out of a genuine desire and drive to help others learn and make a difference to their lives. Many see it as a vocation and, while this makes them a very valuable asset, it also makes them a vulnerable one.

Today education is not just about teaching, and school staff can come into contact with children with complex emotional needs, such as: having been affected adversely by the pandemic; having lost loved ones; having suffered trauma or adverse childhood experiences; having special educational needs; experiencing mental health problems; being affected by bullying; coping with the upset of a parental separation, to name just a few. For school staff, this comes on top of a challenging workload and the pressure to meet Ofsted targets.

With so much to cope with, it’s not surprising that school staff can lose hope and feel burned out, and sometimes suffer vicarious trauma from the children with whom they come into contact. 

Most of the statutory and mandatory training school staff receive is based around physical health and safety or acts and laws to protect them and those they work with. What is missing is ‘emotional’ health and safety.

If you are employed to do a physically dangerous job your employer is required to ensure that you have all the correct equipment and training to minimise the chances of an accident. This has produced a consistent drop in the numbers of people killed or injured at work. The lack of consideration for emotional health and safety has had the opposite effect.

Compassion fatigue

The recognition of compassion fatigue is attributed to Dr Charles Figley, an American professor and expert in trauma in the 1980s. He observed that many of the people he worked with suffered from remarkably similar symptoms to those they were caring for, even though the trauma was not happening directly to them. Those working in caring roles are typically diagnosed with stress or burnout, but Figley and his team identified ‘compassion fatigue’ as being something very different.

Although the symptoms are similar, the underlying cause is different. Someone working in a high-pressure environment, such as the stock exchange, will feel under enormous pressure to perform, and this pressure can turn into stress. However, someone working with vulnerable children can experience vicarious trauma (or secondary stress). This is defined as trauma witnessed by or described to a person.

Humans have become the dominant force on the planet through our intelligence and adaptability, not through strength. Our highly tuned central nervous system constantly scans the environment for signs of danger which, when detected, automatically initiates the fight or flight response to keep us safe. Our ability to react in the same way to perceived threats (think how you respond to fire alarm even if you don’t see the fire) is just as important to keep us safe. This innate emotional and physical response combined with natural empathy ensures that caring people are constantly having to deal with these symptoms. Without training in the causes of compassion fatigue and its symptoms, individuals will either ignore it or try to suppress it. This will inevitably lead to both physical and psychological consequences.

The phases of compassion fatigue

In order to understand what response is appropriate, it is important to view compassion fatigue as having phases.

Anxiety phase

You will experience the effects of adrenalin, which include raised heart and breathing rates, shaking and muscle tension. You will find it hard to think clearly and concentrate and may have trouble sleeping. You may find you become hypervigilant and cannot relax, and are very impulsive.

Your body does not want you to make measured, considered decisions. It needs quick ones so you can move on, leading to skewed thinking. You might be telling yourself you’re the only one doing the job properly. You may be the first one in and the last one out from work. You know your job is stressful, but you are fine and get irritated if anyone asks if you’re OK. Outside of work you may find yourself volunteering for extra activities at clubs or societies, or challenging yourself with sports or hobbies. You may have become accustomed to the feeling of anxiety and actively seek out the feeling. For example, when you’re on holiday you find it impossible to relax and trying to relax is stressful.

Irritability phase

You start to lose compassion and empathy and find the people you are caring for irritating. You may feel the people around you (at work and home) put unreasonable demands on you. You may feel guilty about this. You may tell yourself there is nothing you can do to change the situation and that if you just ignore the feeling, it will go away. You may justify using alcohol or eating unhealthily to help you cope.

You may notice that your body is ‘not OK’. You may experience headaches, fatigue and multiple minor illnesses. It is also very common to suffer from chronic neck and back pain.

Withdrawal phase

You may tell yourself the only way to carry on is to shut out the world after work. You may not feel like talking to anyone about how you feel as they will not understand, so begin to withdraw from colleagues, family and friends. You may feel angry at the world and justified in complaining about work and colleagues. You may admit to feeling differently about work, feel guilty that you are not as engaged as you were and aware you are protecting yourself emotionally. You’re not going to admit it, but those who know you might describe you as negative or pessimistic. You may take time off work, but you don’t feel any better on your return.

Robot phase

The physical symptoms are similar to those experienced by people with depression. You tell yourself that just turning up and ‘doing the job’ is the best way to be. Nothing good is going to come from doing anything positive and nothing bad is going to come from being negative. Empathy and compassion for the people you care for is no longer required; the functional requirements are all that matter. You may admit that you are not coping and so feel resentful towards others who are. You are staying in your job because you’re unable to do anything else. You are often described by others as being ‘hard’ and, if approached, will often shut them down if you perceive them as being emotional. This is a lonely place to be and often leads to people deciding to leave, being complained about or going off on long-term sick leave.

I cannot emphasise enough that all of these reactions to vicarious trauma are normal. However, the problems occur when you get ‘stuck’ in one or two phases and either do not recognise that this is where you are or, like most of us, think that things will just get better. The reality is that individuals must have the same attitude towards their emotional performance as an athlete has towards their physical performance.

Emotional resilience

The concept of emotional resilience is an essential tool to enable people to cope with the psychological demands of the job. Recognising the emotional impact of compassion fatigue and being able to identify the symptoms enables individuals to know when there is an issue that needs to be addressed.

In my training I use the analogy of a river to demonstrate the importance of having a good source of emotional energy. Without a good water source the river runs dry, but a plentiful supply will ensure that any rocks and difficulties are easily dealt with. Although educators and support staff in schools gain a great deal of personal satisfaction and reward from their jobs, they also need outside sources of emotional energy, be that from relationships, hobbies, sport, leisure activities or something else.

Prioritising these during times of stress ensures your reservoir is refilled. Schools need to understand this and, in the same way as they monitor physical health and safety, they must monitor emotional health and safety.

A cultural shift

The pandemic has caused a lot of suffering and heartache for those working in all sectors and schools are realising that investing in the emotional health and wellbeing of their staff is essential. Their previous reluctance to invest in ‘something that hasn’t happened yet’ has started to disappear. The thought that highlighting the job as emotionally challenging will make staff go off sick has been replaced by the knowledge that staff already know it’s emotionally demanding, and many are already suffering and off sick. If staff know an activity will physically hurt them if not done correctly, they will find the correct way to do it; the same will happen if they know the role may have an emotional impact on them. Once staff know how to strengthen and maintain their emotional resilience, they use the tools we teach them and sickness rates go down.

Schools need a cultural shift to giving emotional health and safety an equal importance and worth as physical health and safety. It should be part of all induction training, mandatory yearly training and incorporated into all managers’ training so there is a deeper understanding of the true cost of caring.

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About Author


Jayne Ellis is the Founder and CEO of EF Training. She has worked as a nurse and educator for over 30 years. During that time she has suffered the effects of compassion fatigue and realised that in order to care for others she must care for herself. She set up EF Training in 2016 to address the gap that exists in training staff about the impact of compassion fatigue and to help people create and sustain their emotional resilience. Thirteen years ago, during a very stressful period in her life, Jayne met her horse Phoebe, who helps her cope with the work she does. Phoebe is her ‘responsible selfishness’.

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